Notice of Privacy Practices
This Notice of Privacy Practices ("Notice") is intended to comply with the Gramm-Leach-Bliley Act ("GLBA"), Health Insurance Portability
and Accountability Act ("HIPAA") Privacy and Security Rules, Health Information Technology for Economic and Clinical Health Act ("HITECH
Act"), the Patient Protection and Affordable Care Act ("ACA"), and the Health Care Education Reconciliation Act of 2010.
THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE HEALTH, PERSONAL, MEDICAL, AND FINANCIAL INFORMATION ("YOUR PROTECTED HEALTH INFORMATION" or
"YOUR INFORMATION") WE MAINTAIN ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. THIS NOTICE IS FOR YOUR INFORMATION.
PLEASE REVIEW IT CAREFULLY. NO RESPONSE IS REQUIRED.
This Notice describes the privacy practices of The Accountable Care Coalition of Tennessee, and its subsidiaries ("we," "us," or
"our"). We own, operate, and/or provide administrative and management services to health care organizations, including, but not limited to, medical
OUR PRIVACY OBLIGATIONS
We are required by federal and state law to protect the privacy of Your Protected Health Information and to provide you with this Notice of our legal duties
and privacy practices. When we use or disclose Your Protected Health Information, we are required to abide by the terms of this Notice (or other notice in
effect at the time of the use or disclosure). State Pre-emption — Some states' laws are more stringent than federal privacy laws with regard to these
requirements. We will comply with all applicable laws.
HOW WE PROTECT YOUR PROTECTED HEALTH INFORMATION
We treat Your Protected Health Information in a confidential manner. Our employees are trained and required to protect the confidentiality of Your Protected
Health Information. Employees may access Your Protected Health Information only when there is an appropriate reason to do so, such as to administer or offer
our products or services. We also maintain physical, electronic and procedural safeguards to protect Your Protected Health Information;
these safeguards comply with all applicable laws. Employees are required to comply with our established policies.
HOW WE COLLECT YOUR PROTECTED HEALTH INFORMATION
The information that you give us or that we receive in relation to our products or services generally provides all of Your Protected Health Information we
will need. If we need to verify Your Protected Health Information or need additional information, we may obtain Your Protected Health Information from third
parties such as Medicare, adult family members, employers, insurers, consumer reporting agencies, physicians, hospitals and other medical personnel. Your
Protected Health Information collected may relate to your finances, employment, health, avocations or other personal characteristics as well as transactions
with us or with others.
DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
How We Use Your Protected Health Information
We collect and use Your Protected Health Information for business purposes with respect to our products, services and other business relationships involving
you. We may disclose any of Your Protected Health Information, within acceptable regulatory limitations, when we believe it necessary for the conduct of our
business, or where disclosure is required by law. For example, Your Protected Health Information may be disclosed to others, including to enable them to
provide business services for us, such as helping us to administer our products or services, perform general administrative activities, or otherwise assist us
in servicing or processing a product or service requested or authorized by you. Your Protected Health Information may also be disclosed for audit or research
purposes, or to law enforcement and regulatory agencies, for example, to help us prevent fraud. Your Protected Health Information may be disclosed to others
that are outside of our family of companies, such as companies that process data for us, companies that provide general administrative services for us, federal
or state agencies or regulatory bodies, and consumer reporting agencies. We will make other disclosures of Your Protected Health Information as permitted by
I.Uses and Disclosures for Treatment, Payment, and Health Care Operations:
A. We may use and disclose Your Protected Health Information to others as necessary for health care providers to render medical services,
including evaluation, diagnosis, and treatment, for payment related to our products or services, and for health care operations, without your express, implied,
or specific consent or authorization. In addition and without limitation, we may use and disclose Your Protected Health Information to others as follows:
1. Payment. We may use and disclose Your Protected Health Information to obtain payment relating to our products and services.
2. Health Care Operations. We may use and disclose Your Protected Health Information for our health care operations - for example, to do business
planning, provide care coordination services, and conduct quality assessment and improvement activities.
3. Treatment. We may disclose Your Protected Health Information, such as your medical information, to a health care provider for your medical
II.Use or Disclosure with Your Authorization:
We may use or disclose Your Protected Health Information for any reason other than payment, health care operations and treatment only when (1) you give us
your written authorization ("Your Authorization") or (2) there exists an exception as described in Section III below. You may revoke Your
Authorization, except to the extent we have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified at
the end of this document.
III.Uses and Disclosures without Your Consent or Your Authorization:
A. As Required by Law. We will use or disclose Your Protected Health Information when required to do so by applicable international, federal, state
or local law.
B. Business Associates. We may disclose Your Protected Health Information to our Business Associates that perform functions on our behalf or
provide us with services if the disclosure is necessary for such functions or services. For example, we may use another company to perform administrative
services on our behalf. All of our Business Associates are obligated, by law and under contracts with us, to protect the privacy of Your Protected Health
Information and are not allowed to use or disclose any information other than as specified in our contract.
C. Marketing Communications. We may use and disclose Your Information for marketing communications made by us to you as permitted by law.
D. Public Health Activities. We may disclose Your Protected Health Information for the following public health activities and purposes: (1) to
report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse or
neglect to the government authority authorized by law to receive such reports; and (3) to alert a person who may have been exposed to a communicable
E. Victims of Abuse, Neglect or Domestic Violence. We may disclose Your Protected Health Information if we reasonably believe you are a victim of
abuse, neglect or domestic violence to the appropriate state agency as required or permitted by applicable state law.
Health Oversight Activities. We may disclose Your Protected Health Information to a government agency, including the Centers for Medicare and
Medicaid Services ("CMS"), that
F. Judicial and Administrative Proceedings. We may disclose Your Protected Health Information in the course of a judicial or administrative
proceeding in response to a legal order or other lawful process.
H. Law Enforcement Officials. We may disclose Your Protected Health Information to the police or other law enforcement officials as required by law
or in compliance with a court order or other lawful process.
I. Health or Safety. We may disclose Your Protected Health Information to prevent or lessen a serious and imminent threat to a person's or the
public's health or safety.
J. Specialized Government Functions. We may disclose Your Protected Health Information to units of the government with special functions, such as
any branch of the U.S. military or the
K. Disclosure to You. We may disclose Your Information to you or your authorized representative.
L. Disclosures to Individuals Involved with Your Health Care. We may use or disclose your medical information in order to tell someone responsible
for your care about your location or condition. We may disclose your medical information to your relative, friend, or other person you identify, if the
information relates to that person's involvement with your health care.
M. Research. We may use or disclose Your Protected Health Information, such as your medical information, for purposes of research if we first
confirm that your privacy rights will be protected, for instance if a privacy board or Institutional Review Board determines that your privacy will not be put
at risk and informs us of its determination.
U.S. Department of State.
YOUR INDIVIDUAL RIGHTS
A. For Further Information; Complaints. If you desire further information about your privacy rights, are concerned that we have violated your
privacy rights or disagree with a decision that we made about access to Your Protected Health Information, yous may contact our Privacy Office. You may also
file written complaints with the Secretary of the U.S. Department of Health and Human Services (the "Secretary") Office for Civil Rights. Upon
request, the Privacy Office will provide you with the correct address for the Secretary. We will not retaliate against you if you file a complaint with us or
B. Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of Your Protected Health Information for
treatment, payment, and health care operations in addition to those explained in this Notice. While we will consider all requests for additional restrictions
carefully, we are not required to agree to all requested restrictions, but will comply with legally required restrictions. If you wish to request additional
C. Right to Receive Confidential Communications. We accommodate any reasonable request for you to receive Your Protected Health Information by
alternative means of communication or at alternative locations.
D. Right to Inspect and Copy Your Information. You may request access to our records that contain Your Information in order to inspect and request
copies of your records. Under limited circumstances, we may deny you access to all or a portion of your records. If you desire access to your records, please
obtain a record request form from the Privacy Office and submit the completed form to the Privacy Office. If you request copies, we will charge you a
reasonable free for copying and mailing costs. You also have a right to receive a copy in electronic format, if so requested.
E. Right to Amend Your Records. You have the right to request that we amend Your Information maintained in our records, including case or medical
management records, used, in whole or in part, by or for us to make decisions about you or with respect to our products or services. If you desire to amend
these records, please obtain an amendment request form from the Privacy Office and submit the completed form to the Privacy Office. We will comply with your
request unless special circumstances apply. If your physician or other health care provider created the information that you desire to amend, you should
contact the provider to amend the information.
F. Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of Your Information made by us,
excluding disclosures made earlier than six (6) years before the date of your request. If you request an accounting more than once during a twelve (12) month
period, we have the right to charge you fifty cents ($0.50) per page of the accounting statement and five dollars ($5.00) per hour for clerical work necessary
to complete the requested accounting.
G. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice.
H. Right to Receive Notification of any Security Breaches. If any breach of security relating to Your Information should occur, you have the right
to receive notification. We will abide by breach notification requirements under law.
DURATION OF THIS NOTICE
Our Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice
terms effective for all of Your Information that we maintain, including any information we created or received prior to issuing the new notice. If we change this Notice, we will send the new notice to you if we are providing services to you under our products or services. In
addition, we will post any new notice on our website at www.accoftennessee.com you also may obtain any new notice by
contacting the Privacy Office.
For additional information: In addition to any other Privacy Notice we may provide, federal law establishes privacy standards and requires us to
Policies, please write to us.
You may contact the Privacy Office at:
The Accountable Care Coalition of Tennessee— Privacy Office
c/o WellCare Health Plans
8725 Henderson Road
Tampa, FL 33634